Active NPI
Christopher J Wagner
- Physical Therapist
- Rising Sun, MD
National Provider Identifier
1780908731
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- J10002581
- Practice address
- 52 Rising Sun Town Ctr
Rising Sun, MD 21911-1902 - Phone
- (410) 657-0100
- NPI assigned
- Mar 19, 2010
- Last updated
- Jun 21, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | J10002581 | DE | Primary |
| Physical Therapist | 225100000X | 23588 | MD |
Addresses
Primary practice location
52 Rising Sun Town Ctr
Rising Sun, MD 21911-1902
Mailing address
790 Remington Blvd
Bolingbrook, IL 60440-4909
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P01033233 | Other | MD | MEDICARE RAILROAD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23558 | MD | MD | Pharmacist |
| J10002581 | DE | MD | Physical Therapist |
| 23588 | MD | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1268956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340236800000",
"number": "1780908731",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "790 REMINGTON BLVD",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604404909"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "52 RISING SUN TOWN CTR",
"city": "RISING SUN",
"state": "MD",
"postal_code": "219111902",
"telephone_number": "410-657-0100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "CHRISTOPHER",
"middle_name": "J",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-03-19",
"last_updated": "2012-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "DE",
"license": "J10002581",
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MD",
"license": "23588",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "P01033233",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rising Sun, MD
- Thrive Counseling & Wellness Center
- Thrive Counseling & Wellness Center
- Union Hospital of Cecil County (Rising Sun Diagnostic Center)
- Union Hospital of Cecil County (Rising Sun Diagnostics-Lab)
- Jeffrey Michael Vari, D.P.T.
- Dorcas Njoki Waichigo
- Christina A Wattenschaidt, LMSW
- Joseph Kern Weidner Jr., M.D.
- Jennifer Lynn White, LMSW
- Wolf Medical Group, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.